Agenda and minutes

The Chair welcomed those present and led introductions.

Apologies for absence were received from Councillor March, Councillor Fonseca, Councillor Aldred and Ruth Lake

Apologies for absence were also received from Councillor Waller who it was noted was participating remotely at the discretion of the Chair. The Chair clarified rules around attendance in person and restrictions on members attending remotely in terms of voting.

Members are asked to declare any pecuniary or other interests they may have in the business on the agenda.

Members were asked to declare any pecuniary or other interests they may have in the business on the agenda.

Councillor Morgan declared that his wife was the patron of a wellbeing café in Loughborough and ran a Crisis café.

Councillor Hack declared that she worked with Advanced Housing in the County providing long distance accommodation.

Councillor Waller declared that she was the Rutland County Council nominated Trustee to the Carlton Hayes Mental Health Charity.

Councillor King declared that he was involved with the Carers Centre Leicestershire.

Members retained an open mind for the purpose of discussion and any decisions being taken and were not therefore required to withdraw from the meeting.

Members to receive a report and joint presentation from CCGs and LPT, explaining the proposals and associated background information in relation to the Step Up to Great Mental Health Consultation, as well as analysis of responses and highlighted themes.

Members of the Committee received a report and presentation providing details of the Step Up to Great Mental Health programme to improve and transform mental health services, which included the findings and analysis to the Step Up to Great Mental Health Consultation and an overview of the final proposals in the decision-making business case.

Andy Williams, Chief Executive Officer LLR Integrated Care introduced the report and gave a presentation with focus into the formal public consultation, figures around response levels, and the outcomes from the consultation including how the findings of the consultation were considered and the final proposals in the decision-making business case.

It was noted that the Step Up to Great Mental Health programme was jointly led by CCGs and Leicestershire Partnership NHS Trust (LPT) working with a broad range of partners and part of its purpose was to improve pathways to urgent and emergency mental health care and to strengthen the integration of community mental health services.

The Chair invited members to discuss the report and presentation. The ensuing discussion included the following comments and responses to Members questions.

Members welcomed the depth of consultation however there was some concern around the level of change being represented in the action plan and how that would be implemented. Assurance was given that there was a strong overarching commitment to rebalance mental and physical health and in broad terms resources were already in place. Funding this was not an issue and where necessary funds would be ringfenced. The action plan was about ensuring the programme was co-produced with partners and communities/voluntary sector organisations and that there was a mandate to act so CCG’s and LPT could work with stakeholders to achieve and deliver the best quality care in LLR.

Members were advised that some of the work around co-production was already happening, e.g., tenders were being issued and there was grant funding for more Crisis Cafes and improving learning in the local voluntary sector which was important too. There was continued engagement to bring services closer to local populations and all aspects were being done in partnership including with local authorities as delivery partners.

It was clarified that the term Crisis Café originally came about as the idea of a physical location where people could drop in when they felt unable to cope and needed some support. Crisis Cafes were linked with other services and helped to try to stabilise people and provided a local offer closer and more accessible to neighbourhoods with links to wider community assets too. At the moment Crisis Cafes were not including children as they would need a different environment, however LPT had tried out “Chill out Zones” this year which was a similar idea to a Crisis Café targeted to older children. In relation to plans to expand the number of “Crisis Cafes” grants were usually received in March and expected implementation could take up to 3 months thereafter. Marketing and publicising Crisis Cafes was still to be developed and would be wide  ...  view the full minutes text for item 48.

Members to receive a report and presentation providing a summary of the CQC inspection process, along with details of areas of strength and improvement that have been identified.

Members received a report providing details of the Care Quality Commission (CQC) Inspection of Leicestershire Partnership NHS Trust(LPT).

Angela Hillery, Chief Executive, LPT gave a presentation providing details of the CQC Inspection, the three core services inspected, the CQC assessment of LPT and findings together with an overview of the improvements required and steps being taken to progress that.

It was noted that mental health dormitory accommodation continued to be a significant priority area to improve, and it was national policy to move the programme on and eliminate shared sleeping arrangements. LPT had a robust 3 year plan in place to eliminate shared sleeping arrangements, taking account of bed numbers and access to capital funding. Phase 1 had completed; Phase II was now underway, and Phase III would see the programme brought to completion.

Other key areas identified for improvements in the inspection included:

·         Issues of timeliness for repairs; storage and cleanliness – steps had been taken to act upon points raised and improve facilities management provided by UHL.

·         Call alarms and accessibility – this had been risk assessed in line with new national guidance since the inspection.

·         Personalised care plans - focus was on embedding this in practice.

·         Learning across teams -  there was focus on learning lessons and embedding that across services too.

·         Mandatory training – prior to Covid LPT were compliant but since they had to redeploy staff and stop face to face which impacted on ability to complete mandatory training. Staff were being supported to attend mandatory training as a priority now covid restrictions had eased.

·         Patient risk – a Quality Improvement programme was in place to address the findings and to monitor the embedding of these actions.

·         Access to psychologist roles/services – recruiting continues to these key roles.

Members noted that the service had continued to make improvements throughout the Covid-19 pandemic and the inspection report recognised that.

Members discussed the report which included the following comments:

In relation to the improvements outlined, most were covered off during January/February 2022 and the action plan showed some steps to complete by March. It was queried whether this meant there was confidence that by April 2022 the standard reached would therefore be good or still requiring improvement should there be an inspection?  It was advised the CQC retained a relationship with LPT, and met regularly to feedback on the findings and implementation of improvements. In terms of the action plan there was a series of actions up to end of April 2022, however the aim to complete mandatory training by end January was impacted by the rise in Omicron variant cases so the timetable was revised, however LPT had been very transparent with CQC over that.

Members were informed there was a shift in mindset, with regular governance and reporting twice a month on the CQC action plan. The action plan focused on quality transformation and any areas going off track were reported to the executive board on a regular basis. The action plan as at today  ...  view the full minutes text for item 49.

The Chair has agreed to take an item of urgent business to allow the submission of a Petition which will then be received and dealt with in accordance with the Council’s procedures.

The Monitoring Officer informs that a petition has been received as follows:

“We, the undersigned, request that joint scrutiny scrutinise the draft constitution of the Leicester, Leicestershire, and Rutland Integrated Care System while there is time to build insights of scrutiny into the final version.

The Integrated Care Board Constitution will establish the governance arrangements for Leicester, Leicestershire, and Rutland. This will include membership of the Integrated Care Board; arrangements for delegating Integrated Care Board powers to sub-committees which may not be required to meet in public or publish their papers and may include commercial or independent sector providers with interests other than the public good; and arrangements for managing conflicts of interest.

These arrangements will affect the operation of the NHS in our area, and we insist on our right to be consulted over these plans.

In several other parts of the country, not only have shadow Integrated Care System leaders published their draft constitution but they have also established formal public consultations to gather public views. By contrast, at the last meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission a request by a member of the committee for a copy of the draft Integrated Care Board constitution was denied and a copy of the national “model” was offered instead. However, while the “model” constitution gives broad structure to assist in the drawing up of the constitution locally, it permits significant local variation. The constitution proposed locally should therefore be formally scrutinised and subjected to a formal public consultation before it is finalised.

In sum, we are requesting that the Leicester, Leicestershire and Rutland Joint Health Scrutiny Committee scrutinise the draft Integrated Care Board constitution and recommend that a formal public consultation exercise is arranged on the amended draft constitution.”

The Committee is asked to receive the Petition in accordance with the Council’s procedures.

The Chair agreed to take an item of urgent business to allow the submission of a petition which would be received and dealt with in accordance with the Councils procedures, on basis that expediency was necessary to ensure transparency of process and public scrutiny before the finalisation of the ICB governance and constitutional arrangements.

The petition was received as follows:

“We, the undersigned, request that joint scrutiny scrutinise the draft constitution of the Leicester, Leicestershire and Rutland Integrated Care System while there is time to build insights of scrutiny into the final version.

The Integrated Care Board Constitution will establish the governance

arrangements for Leicester, Leicestershire, and Rutland. This will include membership of the Integrated Care Board; arrangements for delegating Integrated Care Board powers to sub-committees which may not be required to meet in public or publish their papers and may include commercial or independent sector providers with interests other than the public good; and arrangements for managing conflicts of interest.

These arrangements will affect the operation of the NHS in our area, and we insist on our right to be consulted over these plans.

In several other parts of the country, not only have shadow Integrated Care System leaders published their draft constitution, but they have also established formal public consultations to gather public views. By contrast, at the last meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission a request by a member of the committee for a copy of the draft Integrated Care Board constitution was denied and a copy of the national “model” was offered instead. However, while the “model” constitution gives broad structure to assist in the drawing up of the constitution locally, it permits significant local variation. The constitution proposed locally should therefore be formally scrutinised and subjected to a formal public consultation before it is finalised.

In sum, we are requesting that the Leicester, Leicestershire and Rutland Joint Health Scrutiny Committee scrutinise the draft Integrated Care Board constitution and recommend that a formal public consultation exercise is arranged on the amended draft constitution.”

RESOLVED:

                        That the Petition be received and dealt with in accordance with the Council’s procedures and health partners be put on notice to provide a response to the next meeting.

Prior to the meeting the Chair asked the following questions regarding mental health services, in his own right and received written responses from health colleagues as follows:

Q1 What proportion of outpatient appointments with doctors are taking place remotely and do you have a target for the proportion of outpatient appointments with doctors you would like to take place remotely?

Virtual (video) consultations and telephone consultations were adopted across LPT’s outpatients as a way of ensuring that services were not discontinued across the various lockdown and other restrictive measures across the last two years.  The proportion of contacts (in LPT’s mental health services) that were made using virtual or telephone moved from 2% prior to the pandemic to currently over 80% of contacts.   LPT’s current position, reinforced by the feedback from the public consultation, is not to set a target or fix an expectation on contacts being undertaken virtually but instead be providing a choice to our service users.   LPT have listened to feedback with a mixture of very positive experiences using virtual consultations such as reduced travel, easier and more comfortable experience for the service user as well as some people preferring to physically see a clinician or do not like using telephone or video calling.    

Q2 As you have experienced a growing need for mental health services during the course of the Covid19 pandemic, have you been able to increase your inpatient provision?

LPT put in various temporary measures during the pandemic to better support that need such as direct free phone number, through central access point, and the mental health urgent care hub to help assess and support people presenting with urgent needs.  LPT have also focused on various ways to strengthen community services including the introduction of an community rehabilitation services.  All of these measures were included  in the consultation to sustain them going forward.  The cumulation of these measures has meant that over the course of the last two years there has been a lowering of demand for inpatient services and also reduced length of stay in those services.  This has allowed LPT upgrade the inpatient environments to remove dormitory accommodation and replace with single room accommodation.  LPT has been able to do this without needing to increase the inpatient bed numbers and also avoiding inappropriately sending people of Leicester, Leicestershire and Rutland for acute mental health beds.      

·         Monday 28^th March 2022 at 5.30pm at City Hall

To note the next meeting date on Monday 28^th March 2022 at 5.30pm at City Hall.

There being no further business the meeting closed at 2:04pm.